Medicare Benefits Schedule

The Medicare program (Medicare) provides access to medical and hospital services for all Australian residents and certain categories of visitors to Australia. The Department of Human Services administers Medicare and the payment of Medicare benefits. The major elements of Medicare are described in the Health Insurance Act 1973.

The Medicare Benefits Schedule (MBS) is a listing of the Medicare services subsidised by the Australian Government. The schedule is part of the wider Medicare Benefits Scheme managed by the Department of Health and Ageing (DoHA).

The Health Insurance Act 1973 stipulates that Medicare benefits are payable for professional services. A professional service is a clinically relevant service which is listed on the MBS. A medical service is clinically relevant if it is generally accepted in the medical profession as necessary for the appropriate treatment of the patient.

The MBS can be accessed through MBS online which contains the latest MBS information and is updated as changes to the MBS occur.

The Australian Government is committed to building a comprehensive management framework for the Medicare Benefits Schedule (MBS) to ensure that it supports cost-effective, evidence-based best practice care. The Comprehensive Management Framework for the MBS (CMFM) announced in the 2011-12 Budget, builds on activity commenced under the previous 2 year MBS Quality Framework announced in the 2009–10 Budget.
The CMFM has two main components:

independent expert advice to Government on all new and amended MBS services to be provided by the Medical Services Advisory Committee (MSAC); and

rolling reviews of the quality, safety and fee levels of existing MBS items to examine evidence of the clinical quality and appropriateness of existing MBS items and MBS fees in order to maximise health outcomes for patients.

Applications for funding under the MBS are considered by the Medical Services Advisory Committee (MSAC).

Medical Services Advisory Committee (MSAC)

The principal role of the Medical Services Advisory Committee (MSAC) is to advise the Australian Minister for Health and Ageing on the strength of the evidence relating to the safety, effectiveness and cost-effectiveness of medical technologies and procedures. This advice informs Australian Government decisions about public funding for new, and in some cases existing, medical procedures.

MSAC is a ministerially appointed committee, established in 1998 to improve health outcomes for patients. MSAC includes members with clinical, health administration, health economics and consumer expertise, to inform Government decision making on the circumstances under which public funds should be considered for medical services including those that involve new or emerging technologies and procedures and, where relevant, amendment to existing MBS items, in relation to:

the strength of evidence in relation to the comparative safety, effectiveness, cost-effectiveness and total cost of the medical service;

whether public funding should be supported for the medical service and, if so, the circumstances under which public funding should be supported;

the proposed MBS item descriptor and fee for the service where funding through the MBS is supported;

the circumstances, where there is uncertainty in relation to the clinical or cost-effectiveness of a service, under which interim public funding of a service should be supported for a specified period, during which defined data collections under agreed clinical protocols would be collected to inform a re-assessment of the service by MSAC at the conclusion of that period;

other matters related to the public funding of health services referred by the Minister

How to apply for an MSAC appraisal

Applications can be made by the medical profession, medical industry and others with an interest in seeking Australian Government funding for a new medical technology or procedure.

Pre-assessment documentation to initiate an application to MSAC is available on the MSAC website.